Enhanced External Counterpulsation Group Research Articles

Enhanced external counterpulsation improves sleep quality in chronic insomnia: A pilot randomized controlled study

PurposeTo investigate the short-term efficacy of enhanced external counterpulsation (EECP) on chronic insomnia. MethodsThis is a pilot randomized, participant-blind, and sham-controlled study. Forty-six participants with chronic insomnia were randomly assigned in a 1:1 ratio to receive EECP or sham EECP intervention (total of 35 sessions with 45 min each). The primary outcome was Pittsburgh Sleep Quality Index (PSQI). The secondary outcomes included sleep diary, Hospital Anxiety and Depression Scale (HADS), Short-Form Health Survey (SF12), flow mediated dilation (FMD), serum biomarkers of melatonin, cortisol, interleukin-6, and high sensitivity C-reactive protein. Outcomes were assessed after treatment and at 3-month follow-up. ResultsThe PSQI was significantly decreased in both EECP and sham groups after 35-session intervention (13.74 to 6.96 in EECP and 13.04 to 9.48 in sham), and EECP decreased PSQI more than sham EECP (p = 0.009). PSQI in two groups kept improved at 3-month follow-up. After treatment, the total sleep time, sleep efficiency, FMD value and SF12 mental component of EECP group were significantly improved, and group differences were found for these outcomes. At follow-up, total sleep time, sleep efficiency and SF12 mental component of EECP group remained improved, and group difference for SF12 mental component was found. Post-treatment and follow-up HADS-A significantly decreased in both groups, with no differences between groups. Post-treatment serum biomarkers showed no differences within and between groups. LimitationLack of objective sleep measurement. ConclusionEECP could improve sleep quality and mental quality of life in chronic insomnia and the therapeutic effect maintained for 3 months.

A Randomized Controlled Study of Enhanced External Counterpulsation with Cardiac Rehabilitation in Patients with Nonobstructive Coronary Artery Disease and Coronary Microvascular Dysfunction.

Treatment with enhanced external counterpulsation (EECP) or cardiac rehabilitation (CR) benefits patients with coronary heart disease; this paper intends to explore the feasibility of EECP combined with CR in patients with nonobstructive coronary heart disease (NOCAD) and coronary microcirculation disorders (CMD).In January 2021-2022 month June our income NOCAD patients as the research object, the line of cardiac magnetic resonance (CMR), myocardial perfusion reserve (MPR) < 2.0 coronary microcirculation disorders (CMD, 80 cases). Random indicator method 80 CMD patients divided into two groups, 40 cases in each. Usual treatment group: conventional drugs and CR therapy. EECP treatment group: on the basis of standard treatment group, employ EECP therapy. Comparing the two groups before and after the treatment curative effect cardiac function index, endothelial unction index, adverse cardiovascular events, etc.After EECP treatment, the treatment group showed a higher effective rate compared to the usual treatment group (P < 0.05). EECP group curative effect, left ventricular ejection fraction,plasma NO and vascular endothelial growth factor levels higher than the usual group, the incidence of adverse cardiovascular events is lower than the usual group. The difference was statistically significant (P < 0.05).EECP combined with cardiac rehabilitation in patients with CMD symptoms has better effect and safety and provides reference for treatment of CMD patients.

A study on the immediate effects of enhanced external counterpulsation on physiological coupling.

Enhanced external counterpulsation (EECP) is a non-invasive assisted circulation technique for its clinical application in the rehabilitation and management of ischemic cardiovascular and cerebrovascular diseases, which has complex physiological and hemodynamic effects. However, the effects of EECP on the coupling of physiological systems are still unclear. We aimed to investigate the immediate effects of EECP on the coupling between integrated physiological systems such as cardiorespiratory and cardiovascular systems. Based on a random sham-controlled design, simultaneous electrocardiography, photoplethysmography, bio-electrical impedance, and continuous hemodynamic data were recorded before, during and after two consecutive 30 min EECP in 41 healthy adults. Physiological coupling strength quantified by phase synchronization indexes (PSI), hemodynamic measurements and heart rate variability indices of 22 subjects (female/male: 10/12; age: 22.6 ± 2.1 years) receiving active EECP were calculated and compared with those of 19 sham control subjects (female/male: 7/12; age: 23.6 ± 2.5 years). Immediately after the two consecutive EECP interventions, the physiological coupling between respiratory and cardiovascular systems PSIRES-PTT (0.34 ± 0.14 vs. 0.49 ± 0.17, P = 0.002), the physiological coupling between cardiac and cardiovascular systems PSIIBI-PTT (0.41 ± 0.14 vs. 0.52 ± 0.16, P = 0.006) and the total physiological coupling PSItotal (1.21 ± 0.35 vs. 1.57 ± 0.49, P = 0.005) in the EECP group were significantly lower than those before the EECP intervention, while the physiological coupling indexes in the control group did not change significantly (P > 0.05). Our study provides evidence that the PSI is altered by immediate EECP intervention. We speculate that the reduced PSI induced by EECP may be a marker of disturbed physiological coupling. This study provides a new method for exploring the mechanism of EECP action and may help to further optimize the EECP technique.

The Effect of Enhanced External Counterpulsation on the Vascular State, Indicators of Glycemic Control and Quality of Life in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus

Aim. To study the effect of enhanced external counterpulsation (EECP) on the functional status, quality of life, structural and functional state of the vascular bed, and markers of glycemic control in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (DM).Material and methods. A pilot prospective randomized study included 30 patients with CAD and DM. Using a random number generator, patients were randomized into 2 groups: EECP (n=15) and a comparison group (n=15). All patients (n=30) received optimal medical therapy (OMT) during 3 months of follow-up. Patients in the EECP group underwent a course of EECP (35 hours, cuff pressure: 220-280 mmHg) during the first 7 weeks of the study. At baseline and after 3 months of follow-up, patients in both groups underwent an assessment of clinical status, quality of life (based on the SF-36 questionnaire), as well as a 6-minute walk test to assess exercise tolerance. The dynamics of fasting glucose, postprandial glucose, insulin resistance index (HOMA-IR) and glycated hemoglobin were assessed. Photoplethysmography and applanation tonometry were performed to assess the state of the vascular bed.Results. In the EECP group, after 3 months, there was a decrease in the frequency of angina attacks and an improvement in the functional class of angina according to the Canadian Cardiovascular Society (CCS) classification. A significant improvement in exercise tolerance was revealed [an increase in the 6-minute walking distance by 51 (35; 65) m, p&lt;0.05], as well as an improvement in the physical and mental components of health according to the SF-36 questionnaire. A positive dynamics was shown in relation to the indicators of the state of both large vessels and the microvasculature (p&gt;0.05), with the exception of the reflection index and the stiffness index (p&lt;0.05). There was also a significant decrease in the HOMA-IR [-9.9% (-26.5; -4.0) vs 7.7% (-7.9; 13.8), p=0.004], as well as in the levels of fasting glucose [-10.5% (-15.8; -4.0) vs -2.7 (-8.3; 5.9), p=0.012] in the EECP group, compared with the OMT group.Conclusion. EECP course therapy in addition to OMT has a positive effect on the functional status and quality of life of patients with CAD and DM. After 3 months of observation, there was noted a positive dynamics of the vascular state, as well as markers of glycemic control, and these changes were more pronounced in the EECP group. The results obtained may indicate the effectiveness of EECP as an add-on treatment for this group of patients.

Enhanced external counterpulsation: A new method to alleviate contrast-induced acute kidney injury

BackgroundContrast-induced acute kidney injury (CI-AKI) is a common complication after exposure to contrast media. Renal ischaemia occurs in the initial stage of CI-AKI, however, there are very few effective measures to improve renal perfusion. MethodsA total of 114 patients with an estimated glomerular filtration rate (eGFR) of 60–89 ml/min/1.73m2 were randomly assigned to two groups: enhanced external counterpulsation (EECP) group (N = 57) and control group (N = 57). Two hours after contrast exposure, EECP group received EECP treatment for 1 h while no intervention was performed control group. The primary outcome was the incidence of serum cystatin C concentration to 10% above the baseline concentration at 24 h after contrast administration. The secondary outcomes were the incidence of CI-AKI (defined as an increase in serum creatinine concentration to ≥0.5 mg/dl or by 25% compare to the baseline after contrast exposure), contrast clearance and adverse clinical events. ResultsThe primary outcome was observed in 26 patients (6 EECP and 20 control; 11% vs. 35%; P = 0.002). CI-AKI occurred in four patients (0 EECP and 4 control; 0% vs. 7%; P = 0.042). The clearance rate of iopromide in the initial 3 h was significantly different between EECP and control group (59.92 ± 8.84 vs 46.80 ± 9.26 ml/min/1.73 m2; P < 0.001). No adverse clinical events were observed in this study. ConclusionsThis study demonstrates that EECP increases the contrast clearance and may have an effect in reducing the risk of CI-AKI.The study has been registered in Chinese Clinical Trial Registry (ChiCTR 2,000,039,190).

Abstract 13341: Enhanced External Counterpulsation Attenuates Coronary Microcirculation Dysfunction in Coronary Artery Disease With Diabetes: Primary Results of EECP-CMD Study

Introduction: Coronary microcirculation dysfunction (CMD) is recognized as a pivotal pathophysiological change of coronary artery disease (CAD) with diabetes, however, there is little evidence for CMD medication treatment. Though enhanced external counterpulsation (EECP), a non-invasive therapy to increase shear stress of coronary flow, has been proved to release angina and restore endothelial capacities, whether EECP could attenuate CMD remains unknown. Hypothesis: EECP could attenuate CMD in patients of CAD with diabetes. Methods: This is a single center, prospective, randomized, single blind, control clinical trial (ChiCTR1800019060). Forty-eight patients [age: (57.7±8.5) yrs, 30 males] diagnosed with CAD and diabetes were enrolled during March 2019 and October 2020 in the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China. The main exclusion criteria are as follows: type 1 diabetes or diabetes history≤3 years; ≥ 70 years old; acute coronary syndrome; chronic total occlusion lesions and contraindications for EECP. All accepted coronary angiography and index of microcirculation resistance (IMR) test with pressure wire, then were randomized to EECP (n=24) or control (n=24) group. All followed standard medication therapy as guidelines recommended, EECP group took 35 times of EECP (60 minutes per time, 5 times a week and 7 weeks for whole procedure) after IMR test. Another IMR test would be done at the end of 12-week follow-up, the occurrence of angina and the metabolic parameters, FMD, PWV, CPET and TTE would also be evaluated. Results: The baseline IMR displayed no significant difference in both groups [EECP: (26.56±3.70) vs. Control: (26.91±4.22), P =0.74], while IMR markedly decreased in the EECP group than control at the end of follow-up [(24.02±3.15) vs. (26.78±4.63), P =0.02]. After multivariate linear regression analysis, FMD and PWV were found to independently correlated with IMR change [FMD: (β=0.45, P =0.014); PWV: (β=-0.27, P =0.038)]. Apart from above, EECP reduced angina occurrence and improved exercise tolerance, early diastolic function of left ventricular. Conclusion: EECP attenuates CMD in CAD with diabetes through coronary microcirculation resistance decrease.

51. ENHANCED EXTERNAL COUNTERPULSATION REDUCES BLOOD PRESSURE IN REFRACTORY ANGINA PECTORIS PATIENTS; A SYSTEMATIC REVIEW AND META-ANALYSIS

Refractory angina patients often coexist with hypertension. Uncontrolled hypertension increased the risk of major adverse cardiac event (MACE) and target-organ damage. Enhanced External Counterpulsation (EECP) is a non-invasive treatment that is beneficial in refractory angina pectoris patients. Hemodynamic benefits of EECP to peripheral blood pressure are observed but not yet established. We systematically review the available evidence of the efficacy of EECP in addressing systolic and diastolic blood pressure (SBP and DBP) in refractory angina pectoris patients. We conducted a literature search in MEDLINE and ResearchGate from its inception to January 2021. We included studies that reported SBP and DBP measurement at baseline and after EECP treatment in refractory angina patients. We conducted a meta-analysis of weighted mean differences from baseline to post-intervention for SBP and DBP. We identified 22 studies from 17 articles (n = 1564) consisting of 12 articles EECP only and six articles EECP vs control. Within EECP group, EECP treatment significantly reduce SBP by 6.7 mmHg (MD −6.77, 95%CI −9.09 to −4.45, p = &lt;0.00001, I 2 = 71%) and DBP by 3 mmHg (MD −3.03, 95%CI −4.07 to −2, p = &lt;0.00001, I 2 = 49%). Between-group, EECP treatment compared to control could reduce SBP by 9.1 mmHg (MD −9.15, 95%CI −15.75 to −2.56, p = 0.007, I 2 = 80%) and SBP by 2.6 mmHg (MD −2.68, 95%CI −5.52 to −0.17, p = 0.07, I 2 = 63%). Conclusion: EECP treatment provides additional benefits that reduce SBP and DBP in refractory angina pectoris patients to support controlling hypertension and reduce the risk of MACE and target-organ damage.

External Counterpulsation Attenuates Hypertensive Vascular Injury Through Enhancing the Function of Endothelial Progenitor Cells.

BackgroundVascular injury is a landmark of hypertension and enhanced external counterpulsation (EECP) has been identified as a noninvasive treatment to restore the capacity of endothelial cells. However, the effect of EECP on blood pressure lowering in hypertension and the potential mechanism remain unknown.MethodsWe measured the ambulatory blood pressure (AMBP) and flow-mediated endothelial dilation (FMD) in the essential hypertensive patients who were randomly assigned to the EECP group (n = 20) or control group (n = 20). We also evaluated in vitro function of endothelial progenitor cells (EPCs). Furthermore, multivariate analysis was performed to determine the actual correlation between EPC function and FMD.ResultsCompared with the control, EECP group exhibited decreased systolic [(133.2 ± 4.9) mmHg vs. (139.3 ± 6.4) mmHg, P < 0.05] and diastolic [(83.4 ± 4.5) mmHg vs. (89.5 ± 7.6) mmHg, P < 0.05] blood pressure and increased FMD value [(8.87 ± 2.46%) vs. (7.51 ± 2.32%), P < 0.01]. In addition, the migration [(47.3 ± 6.4)/hpf vs. (33.4 ± 5.1) hpf, P < 0.05] and adhesion [(45.1 ± 5.5)/hpf vs. (28.4 ± 3.9) hpf, P < 0.05] functions of EPCs in the EECP group were improved significantly, whereas no change was observed in the control. Both migration [odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.27–0.64, P < 0.05] and adhesion (OR = 0.44, 95% CI = −0.0034 to 0.0012, P < 0.05) of EPCs correlated with FMD. After multivariate analysis, the migration (β = 3.37, 95% CI = 1.67–5.33, P < 0.05) and adhesion (β = 3.98, 95% CI = 1.12–6.43, P < 0.05) functions still independently correlated to FMD.ConclusionThe present study demonstrates for the first time that EECP decreases both systolic and diastolic blood pressure and increases FMD value in hypertension. The fall in endogenous EPCs repair capacity might be an important mechanism of hypertensive vascular injury and could be restored by EECP.

The Effect of Enhanced External Counterpulsation on Platelet Aggregation in Patients with Coronary Heart Disease.

Resistance to antiplatelet therapy, especially aspirin or clopidogrel, triggers other therapies for patients with coronary heart disease (CHD). Enhanced external counterpulsation (EECP) is a noninvasive, pneumatic technique that provides beneficial effects for patients with CHD. However, the physiological effects of EECP have not been fully studied, and the role of EECP on platelet function remains poorly understood. A total of 168 patients with CHD were finally selected from the Second Xiangya Hospital and randomly assigned to either a control group or EECP group. The control group accepted only standard medical treatment, while the EECP group accepted standard medical treatment and EECP treatment. Blood samples were collected from patients at baseline and after EECP, and platelet aggregation was assessed. Changes in platelet aggregation were compared before and after treatment. There was no difference in the basal levels of arachidonic acid (AA) induced platelet maximum aggregation ratio (MAR) between the two groups. The AA-induced platelet MAR was significantly decreased after EECP therapy. The logistic analysis showed that low HDL-C was not favorable for the decrease in platelet aggregation. EECP therapy is favorable for lowering platelet aggregation in patients with CHD, especially the AA-induced platelet aggregation ratio.

Evaluation of enhanced external counterpulsation therapy for nonarteritic anterior ischemic optic neuropathy

BackgroundTo explore the effects of enhanced external counterpulsation (EECP) and its underlying influencing factors in nonarteritic anterior ischemic optic neuropathy (NAION) patients.MethodsPatients at Zhongshan Ophthalmic Center with recent-onset (< 8 weeks) NAION were retrospectively recruited. The patients had decided whether or not they would undergo EECP treatment, and the patients who declined were included in the control group. The effectiveness of EECP was evaluated by comparing the visual function and fellow eye involvement in patients with and without EECP treatment.ResultsIn total, 61 patients (76 eyes) were included. Twenty-nine patients (37 eyes) underwent EECP treatment, while 32 patients (39 eyes) were included in the control group. Mean time from NAION onset to EECP initiation was 27.59 ± 16.70 days. In the EECP group, the mean EECP duration was 31.57 ± 18.45 days. EECP was well tolerated by all patients. However, there was no significant difference in visual function between the EECP and control groups. Furthermore, there was no evidence of the effectiveness of EECP in the subgroup analysis of patients with different systemic health conditions. Among the 42 patients with monocular NAION, the sequential attack rate was comparable between the EECP (27.78%) and control (25.00%) groups.ConclusionThis study is the first nonrandomized controlled study to evaluate the effectiveness of EECP in NAION patients. Unfortunately, we failed to demonstrate the effectiveness of EECP in NAION at the 6-month follow-up. Any further application of EECP in NAION patients should be cautious.

Enhanced external counterpulsation improves cardiac function in Beagles after cardiopulmonary resuscitation.

The aim of this study was to investigate the influence of enhanced external counterpulsation (EECP) on the cardiac function of beagle dogs after prolonged ventricular fibrillation. Twenty-four adult male beagles were randomly divided into control and EECP groups. Ventricular fibrillation was induced in the animals for 12 min, followed by 2 min of cardiopulmonary resuscitation. They then received EECP therapy for 4 h (EECP group) or not (control group). The hemodynamics was monitored using the PiCCO2 system. Blood gas and hemorheology were assessed at baseline and at 1, 2, and 4 h after return of spontaneous circulation (ROSC). The myocardial blood flow (MBF) was quantified by 18F-flurpiridaz PET myocardial perfusion imaging at baseline and 4 h after ROSC. Survival time of the animals was recorded within 24 h. Ventricular fibrillation was successfully induced in all animals, and they achieved ROSC after cardiopulmonary resuscitation. Survival time of the control group was shorter than that of the EECP group [median of 8 h (min 8 h, max 21 h) vs median of 24 h (min 16 h, max 24 h) (Kaplan Meyer plot analysis, P=0.0152). EECP improved blood gas analysis findings and increased the coronary perfusion pressure and MBF value. EECP also improved the cardiac function of Beagles after ROSC in multiple aspects, significantly increased blood flow velocity, and decreased plasma viscosity, erythrocyte aggregation index, and hematocrit levels. EECP improved the hemodynamics of beagle dogs and increased MBF, subsequently improving cardiac function and ultimately improving the survival time of animals after ROSC.

Trimetazidine Improves the Outcome of EECP Therapy in Patients with Refractory Angina Pectoris

Introduction:Cardiovascular disease (CAD) associated with death and disability remains a serious medical problem. In some patients the initial clinical coronary artery disease presentation is stable angina pectoris.Aim:The aim of the study was to evaluate the effect of EECP therapy with or without trimetazidine (TMZ) in patients with refractory angina via modulating peripheral monocyte expression of Toll like receptor2 (TLR2) and its downstream signaling.Methods:This is a double-blind randomized prospective study in which 88 stable refractory angina patients allocated into two groups, Enhanced External Counter Pulsation (EECP) group: included 44 patients with stable refractory angina, and were treated with EECP-Therapy. TMZ-EECP group: included 44 patients with stable refractory angina, we gave TMZ 35 mg twice daily in addition to EECP-Therapy.Results:TLR2 expression in peripheral monocyte investigated by flow cytometry and 8-iso-prostaglandin F2β (8-iso-PGF2 β), interleukin1β (IL-1β), heat shock protein 60 (HSP60) and monocytes chemoattractant protein-1(MCP-1) were also measured before the EECP-therapy and before giving TMZ to patients, and after 35 hours of EECP treatment (7 consecutive weeks). Inhibition in TLR2 expression in peripheral monocyte was observed among the EECP group (P<0.05). Inflammatory cytokine MCP-1 was remarkably decreased in both study groups but (heat shock protein 60 (HSP60), MCP-1 and interleukin-1β (IL-1β)) significantly decreased levels were observed among the TMZ-EECP group (P<0.05). Also, the oxidative stress biomarker 8-iso-prostaglandin F2β (8-iso-PGF2β) was decreased in both study groups but significantly decreased levels were observed among the TMZ-EECP group (P<0.05). TMZ and EECP therapy in patients with stable refractory angina remarkably decreased the inflammatory markers HSP60, MCP-1 and IL-1β in serum levels also the decreased levels were found in serum levels of oxidative stress marker 8-iso-PGF2β serum level.Conclusion:EECP-therapy decreased the expression of TLR2 on peripheral monocytes in patients with chronic stable refractory angina which yield improvement in the quality of patients’ life by decreasing the frequency of angina episodes, decreasing the Short-acting nitrate use and change the exercise tolerance and distance.

Enhanced external counterpulsation treatment attenuate the injury of brain dog model of cardiac arrest

Objective To investigate the therapeutic effects of enhanced external counterpulsation (EECP) on cerebral edema and cerebral blood flow perfusion with MRI following cardiac arrest (CA) and on successful return of spontaneous circulation (ROSC) by cardiopulmonary resuscitation (CPR) in dogs.Methods Sixteen beagle dogs were induced CA with alternating current on epicardium,then were randomly (random number) divided into the EECP and control group after successful ROSC.MR scanning brain of all animals was carried out by diffusion-weighted imaging (DWI) and perfusion weighted imaging (PWI) before CA and on the first,second and third days after ROSC.Blood pressure,right common carotid artery flow,and intracranial microcirculation perfusion were measured.Results There were no significant differences in mean artery pressure at all intervals between two groups (P ＞ 0.05).There was significant increase in right common carotid artery blood flow and intracranial microcirculation of dogs in EECP group compared with the control group (P ＜ 0.05).Apparent diffusion coefficients (ADC) of water molecule on the first and third days after ROSC were significantly higher in the EECP group than those in the control group (P ＜ 0.05).Ratios of post-ROSC relative cerebral blood flow (RCBF) /original cerebral blood flow were higher in the EECP group than those in the control group on the first,second and third days after ROSC (P ＜ 0.05).Conclusions EECP treatment could improve cerebral blood flow perfusion and relieve ischemic cerebral edema,alleviating brain injury in dogs following CA and successful ROSC. Key words: Enhanced external counterpulsation; Cardiac arrest; Cardiopulmonary cerebral resuscitation; Magnetic resonance imaging; Microcirculation; Dog

Enhanced External Counterpulsation Reduces Indices of Left Ventricular Wasted Energy and Myocardial Oxygen Demand in Patients with Left Ventricular Dysfunction and Refractory Angina

Enhanced external counterpulsation (EECP) therapy decreases angina episodes and improves quality of life in patients with left ventricular dysfunction (LVD). However, the underlying mechanisms of EECP therapy in patients with LVD have not been fully elucidated. The purpose of this study was to investigate the effects of EECP on indices of central hemodynamics, aortic pressure wave reflection characteristics and estimates of LV load and myocardial oxygen demand in patients with LVD. Patients with chronic stable angina and left ventricular ejection fraction (LVEF) &lt;40%, but &gt;30%, were randomized to either an EECP (LVEF=35.1±4.6%; n=10) or sham‐EECP (LVEF=34.3±4.2%; n=7) group. Pulse wave analysis of the central aortic pressure waveform and LV function were evaluated by applanation tonometry before and after 35 1‐hr sessions of EECP or Sham EECP. EECP therapy was effective in reducing indices of left ventricular wasted energy and myocardial oxygen demand by 25% and 19%, respectively. In addition, indices of coronary perfusion pressure and subendocardial perfusion were increased by 9% and 30% after EECP, respectively. Our data indicate that EECP may be useful as adjuvant therapy in heart failure patients through reductions in central blood pressure, aortic pulse pressure, wasted left ventricular energy, and myocardial oxygen demand which suggests improvements in ventricular‐vascular interactions.

Enhanced external counterpulsation reduces indices of central blood pressure and myocardial oxygen demand in patients with left ventricular dysfunction.

Enhanced external counterpulsation (EECP) therapy decreases angina episodes and improves quality of life in patients with left ventricular (LV) dysfunction. However, the underlying mechanisms relative to the benefits of EECP therapy in patients with LV dysfunction have not been fully elucidated. The purpose of this study was to investigate the effects of EECP on indices of central haemodynamics, aortic pressure wave reflection characteristics, and estimates of LV load and myocardial oxygen demand in patients with LV dysfunction. Patients with chronic stable angina and LV ejection fraction < 40% but > 30%, were randomized to either an EECP group (LV ejection fraction = 35.1 ± 4.6%; n = 10) or sham-EECP group (LV ejection fraction = 34.3 ± 4.2%; n = 7). Pulse wave analysis of the central aortic pressure waveform and LV function were evaluated by applanation tonometry before and after 35 1-h sessions of EECP or sham-EECP. Enhanced external counterpulsation therapy was effective in reducing indices of LV wasted energy and myocardial oxygen demand by 25% and 19%, respectively. In addition, indices of coronary perfusion pressure and subendocardial perfusion were increased by 9% and 30%, respectively, after EECP. Our data indicate that EECP may be useful as adjuvant therapy for improving functional classification in heart failure patients through reductions in central blood pressure, aortic pulse pressure, wasted LV energy, and myocardial oxygen demand, which also suggests improvements in ventricular-vascular interactions.

Effect of Enhanced External Counterpulsation and Cardiac Rehabilitation on Quality of Life, Plasma Nitric Oxide, Endothelin 1 and High Sensitive CRP in Patients With Coronary Artery Disease: A Pilot Study.

ObjectiveTo investigate the effect of enhanced external counterpulsation (EECP) on plasma nitric oxide (NO), Endothelin 1 (ET1), high sensitive C-reactive protein (HSCRP) and quality of life (QoL) in patients with coronary artery disease (CAD).MethodsWe conducted a pilot randomized clinical trial in order to evaluate plasma NO, ET1, HSCRP and QoL before and after twenty sessions of EECP (group A) and cardiac rehabilitation (CR, group B) in 42 patients with CAD (21 in each group).ResultsForty-two patients (33 male and 9 female) were included in the study. The mean age was 58.2±10 years. The mean HSCRP was 1.52±0.7 in the EECP group and it was reduced to 1.27±0.4 after intervention. The reduction in HSCRP was not statistically significant in EECP and CR groups with p=0.33 and p=0.27, respectively. There was not significant improvement of NO, ET1, and QoL in the EECP and CR groups shortly after therapy (p>0.05).ConclusionAlthough the short-term EECP treatment in CAD patients improved HSCRP, NO, ET1, and QoL compared with the baseline those improvements are not statistically significant. Further studies are necessary with large study groups and more sessions.

Enhanced external counterpulsation improves cerebral blood flow following cardiopulmonary resuscitation

BackgroundTo investigate the therapeutic value of enhanced external counterpulsation (EECP) on recovery of cerebral blood flow following cardiac arrest (CA) and successful resumption of spontaneous circulation (ROSC) by cardiopulmonary resuscitation. MethodsCA models were conducted using beagle dogs induced by alternating current. After successful ROSC by cardiopulmonary resuscitation, 16 dogs were randomly divided into the EECP and control group (n = 8 per group). Dogs underwent dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging at baseline prior to CA and during the 3 days following ROSC. Mean blood pressure, right common carotid artery blood flow, intracranial microcirculation and blood lactate levels were measured. Neurological outcome was assessed by the neurologic deficit score. Hematoxylin-eosin staining and transmission electron microscopy were performed for morphology and microconstruction of the cerebral cortex. ResultsThe EECP group exhibited a significant elevation in right common carotid artery blood flow, intracranial microcirculation and a substantial decrease in blood lactate levels relative to the control group. Relative cerebral blood flow and volume were higher in the EECP group during the 3 days. Apparent diffusion coefficients were significantly higher in the EECP group on the first and third days. After ROSC, the neurologic deficit score was significantly higher in the control group compared to those in the EECP group during the three days of experiment. The cell swelling of neurons and increase of mitochondrial mass were more pronounced in the control group. ConclusionEECP is beneficial for recovery of cerebral blood flow and attenuation of ischemic cerebral edema following CA and successful ROSC.

Effect of enhanced external counterpulsation therapy on myeloperoxidase in lowering cardiovascular events of patients with chronic heart failure

Background: Chronic heart failure (CHF) is a slowly progressive disease with high morbidity and mortality; therefore, the management using pharmacological treatments frequently fails to improve outcome. Enhanced external counterpulsation (EECP), a non-invasive treatment, may serve as alternative treatment for heart failure. This study was aimed to evaluate the influence of EECP on myeloperoxidase (MPO) as inflammatory marker as well as cardiac events outcome. Methods: This was an open randomized controlled clinical trial on 66 CHF patients visiting several cardiovascular clinics in Manado between January-December 2012. The subjects were randomly divided into two groups, i.e. the group who receive EECP therapy and those who did not receive EECP therapy with 33 patients in each group. Myeloperoxidase (MPO) as inflammatory marker was examined at baseline and after 6 months of observation. Cardiovascular events were observed as well after 6 months of observation. Unpaired t-test was use to analyze the difference of MPO between the two groups, and chi-square followed by calculation of relative risk were used for estimation of cardiovascular event outcomes. Results: MPO measurement at baseline and after 6 months in EECP group were 643.16 ± 239.40 pM and 422.31 ± 156.26 pM, respectively (p < 0.001). Whereas in non EECP group, the MPO values were 584.69 ± 281.40 pM and 517.64 ± 189.68 pM, repectively (p = 0.792). MPO reduction was observed in all patients of EECP group and in 13 patients (48%) of non-EECP group (p < 0.001). Cardiovascular events were observed in 7 (21.21%) and 15 (45.45%) of patients in EECP and non-EECP groups, respectively (p = 0.037). Conclusion: EECP therapy significantly decreased the level of MPO as inflammatory marker and this decrease was correlated with the reduction of cardiovascular events in CHF patients. (Med J Indones. 2013;22:152-60. doi: 10.13181/mji.v22i3.584) Keywords: CHF, cardiovascular events, EECP, myeloperoxidase

The observation of curative effect of enhanced external counter pulsation as an adjunctive therapy for nonarteritic anterior ischemic optic neuropathy

Objective To observe the efficiency and security of enhanced external counter pulsation (EECP) as an adjunctive therapy for nonarteritic anterior ischemic optic neuropathy (NAION).Methods This was a retrospective case-control study.Forty-eight patients (48 eyes) with NAION were enrolled in this study.Thirty-two patients (32 eyes) who had been treated with blood vessel dilation and nerve nutrition drugs comprised the medicated group.Sixteen of the patients (16 eyes) in the medicated group were treated with EECP combined with blood vessel dilating and nerve nutrition drugs as EECP group.The differences were not statistically significant between groups in gender(x2 =0.000),age (t=1.096),course (t=1.613) and visual acuity (x2=0.000,P＞0.05).EECP was done once a day,one hour per time,five times a week.Fourteen eyes were treated 12 times EECP and two eyes were treated 36 times EECP within the EECP group.Systemic and ocular side effects were observed during EECP treatment.Corrected visual acuity was examined after treatment and the differences of visual acuity between medicated group and EECP group treated six times and or 12 times with EECP treatment were analyzed.The correlation of visual acuity level,and course,and acuity before treatment were analyzed.A significant improvement in visual acuity was defined as a sustained improvement of three or more visual acuity gradations.An effective of treatment was defined as a sustained improvement of two or less visual acuity gradations.No effective of treatment was defined as visual acuity dropped or showed no progress.Results After six treatments of EECP,within the 16 eyes of EECP group,two eyes achieved significant improvement,five eyes had effective improvement,and nine eyes did not show any improvement.Within the 32 eyes of medicated group,three eyes achieved significant improvement,eight eyes had effective improvement,and 21 eyes did not show any improvement.There was no statistically significant difference in vision between the two groups (x2 =0.404,P＞ 0.05).After 12 treatments of EECP,within the 16 eyes of EECP group,six eyes achieved significant improvement,nine eyes had effective improvement,and one eye did not show any improvement.Within the 32 eyes of medicated group,four eyes achieved significant improvement,10 eyes had effective improvement,and 28 eyes did not show any improvement.The difference was statistically significant comparing the vision level between the two groups (x2 =11.621,P＜0.05).The curative effect of patients negatively correlated with course of the disease (r =-0.860,P＜ 0.05),but positively correlated with visual acuity before treatment (r=1.380,P＜0.05).Skin bruises,hematoma,new retinal bleeding and other side effects did not occur in patients during EECP treatment.Conclusions Many-time therapy of EECP can improve vision of NAION patients.There is no local and general complications after a certain number of therapy. Key words: Optic neuropathy, ischemic/therapy; Optic neuropathy, ischemic/drug therapy; Counterpulsation/utilization

LONG-TERM ENHANCED EXTERNAL COUNTERPULSATION DOWNREGULATES THE MACROPHAGE MIF-1α EXPRESSION OF VASCULAR ENDOTHELIAL CELLS IN ATHEROSCLEROTIC PIGS

ObjectivesMechanisms underlying the beneficial effects of Enhanced External Counterpulsation (EECP) in atherosclerotic diseases are not well defined. Since macrophage Migration Inhibitory Factor (MIF), as a novel pro-inflammationary and immuno-regulatory factor,...